This concerto was commissioned by the Northern Sinfonia with funds provided by the Calouste Gulbenkian Foundation, and is scored for piano solo, a concertante group of nine instruments, and small orchestra, the whole adding up to a classical-sized orchestra. Thus, the material is developed on three levels, as it were: solo, concertino, and orchestra (the sub-title indicates the importance of the concertino group), and they combine, develop and juxtapose the basic ideas in various ways through the course of the music. Formally, the concerto falls into seven sections played without a break, as follows:

The Maestoso is an aggressive opening statement, with cadenza-like flourishes and important orchestral chords superimposed. It slowly quietens to lead to the Andante lirico, in which the piano introduces a long melodic line that dominates this movement and provides a kind of thematic reservoir for much of the remainder of the work. The third section is a short, fairly light scherzo.

The first extended slow movement (Lento) starts with an intense piano line that gives way gradually to a more atmospheric variation of some of the work's main ideas. The Vivo is a fast, skittering scherzo in a rhythm of seven beats to the bar, with a more vehement, pounding middle section.

The second of the two main slow movements (Lento) begins with a slowly moving section for the concertino ensemble, followed by a more richly textured lyrical part using full orchestra and solo piano as well as the concertino. The opening bars return to lead into the finale (Allegro). This combines rondo and variation forms with a prevalence of toccata texture. It starts quietly, but from the entry of the main theme (pounding piano octaves) it pushes forward to the orchestral return of the concerto's opening chords, bringing it to a stormy conclusion.